Massachusetts’ Health Care Success Story and Why the Affordable Care Act is Constitutional

Wednesday, February 8, 2012, 6:00 am ET - 07:00 am ET

On February 8 the Center for American Progress hosted an event featuring Massachusetts Attorney General Martha Coakley, where she discussed the success of the Massachusetts health care reform law signed by former Gov. Mitt Romney (R) in 2006.

Attorney General Coakley discussed the framework of the law and explained how it’s played an essential role in providing unparalleled access to health care coverage for Massachusetts residents. She and CAP President Neera Tanden also discussed why the Affordable Care Act’s adoption of the Massachusetts framework fits comfortably within the United States’ constitutional authority.

In her introductory remarks, Tanden said that “the Massachusetts law, though sometimes maligned in our national debates, is actually an incredible success story, and has really demonstrated to the country how effective health care reform can be, and the Affordable Care Act can be.”

Flourish so much, Tanden said, that “98.1 percent of the state’s residents were insured at the end of 2010, compared to 87.5 in 2006, when the health care law started. Almost every child in the state is insured, and premiums in the individual market dropped 40 percent as the Massachusetts law was fully implemented.”

In her speech, Attorney General Coakley described the Massachusetts health care law, saying that “in some, but not all particulars, the Massachusetts Act of 2006 was really the prototype for what has become the Federal Patient Protection and Affordable Care Act.” Like the Affordable Care Act, Massachusetts’ reform includes a state-operated health insurance exchange, subsidies for low- and moderate-income individuals, and a mandate that all individuals who can afford health insurance purchase coverage, or an individual mandate.

Coakley said, “The law has resulted in the highest health care access rates in the nation, it has improved both access to and affordability of health care for hundreds of thousands of residents, while maintaining a high level of quality, and I think that’s important.

“We don’t talk about quality so much, but it’s part of what we are concerned about. Access, cost, quality: Ensuring two is relatively easy, if you want to do all three, not so much. And this has been, and is still, our challenge and our goal, and as a work in progress, I think the facts demonstrate that rather than our experiment proving a risk to the rest of the country, Massachusetts as a test laboratory has a lot to offer.”

She said, “We’ve seen significant improvements in the care of our residents. From 2006 to 2010, adults from all income groups, but in particular lower-income adults, experienced a significant decline in reported unmet health care needs due to cost. … we also have seen significant overall economic benefits for our state as a result of this.”

In terms of costs, she said, “[w]e’ve seen a sharp decline in the amount of spending on the so-called ‘free care,’ [when an uninsured person visits an ER, for example, and costs get passed on to the insured in higher rates] about $300 million, and that’s 33 percent less than we spent in 2006.” And nongroup or individual insurance premiums cost 40 percent less.

Attorney General Coakley also discussed why she believes the Supreme Court will not overturn the individual mandate. Massachusetts, she said, is giving a very positive endorsement for the mandate, and it is “a constitutional act by Congress.” It would be quite surprising if the Supreme Court overturned “the 70 years of precedent that have been set” by case law establishing what Congress has constitutional authority to regulate, including commerce such as health care.

After her speech, Attorney General Coakley spoke with Tanden about health reform. In response to an audience question about the constitutionality of the mandate, Tanden said that “when you say that people have coverage when they go to the emergency room, that immediately means that they’ll be cost-shifting, and the individual mandate is just a way in which people have the same responsibility for their own health care so they’re not shifting costs anymore.”

As Attorney General Coakley asserted, Massachusetts is an essential—and the only U.S. example—of the importance of the individual mandate in ensuring affordable access to health care for all.